RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05178
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060410

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Seaman, medically separated for “right knee post traumatic patellofemoral arthrosis” with a disability rating of 10%.

CI CONTENTION: No specific contention was made. The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20051221	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Post Traumatic…	5299-5003	10%	Degenerative Arthritis Medial Compartment, Right Knee	5010	10%	20061002	
Right Knee Patellar Instability, S/P Fulkerson Procedure	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Knee Post Traumatic Patellofemoral Arthrosis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent remedial surgery for patellar dislocation (arthroscopic Fulkerson procedure) on 27 June 2005 (10 months prior to separation). Post-operative provider entries in the STR documented the absence of complications and restoration of normal or near-normal range of motion (ROM).   A physical therapy entry on      16 August, 2 months after surgery, recorded flexion to 130 degrees (normal 140) and minus 2 degrees extension (normal 0). Several other providers observed grossly normal ROM. There was STR documentation of residual patellar laxity without further dislocations, no persistent effusion, no ligamentous joint instability, no note of impingement (locking), and progression to full weight- bearing with a normal gait.

The 8 November 2005 MEB NARSUM examination, 5 months prior to separation, documented that the CI “still has significant pain and difficulty with knee extension, pivoting, jumping, running, and squatting [and, when walking or running] a sensation of instability and given [Sic] out of the

knee.” The physical examination recorded well healed incisions, patellar tenderness with crepitus, ligamentous stability, and no note of effusion or impingement. Measured ROM was flexion to 110 degrees and extension 0 degrees. The examiner noted risks associated with an “unsteady gait” without clarifying observed gait at the time, although there were flanking STR provider entries that documented a normal gait.

At the 2 October 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported right knee pain (in the context of claimed bilateral knee conditions) “90% of the time” that was rated 6-7/10 with exacerbations to 8-9/10 by prolonged walking (50 yard tolerance) and strenuous sports. He was employed as a fork lift operator. The examiner noted a “stiff-legged gait, walking as if he were on stilts and rocking from side to side,” although a recent (7 July) VA rehabilitation consult had documented "good gait, cadence, and stride length.” The physical examination additionally recorded an effusion, tenderness, joint stability in all planes, and negative impingement. Measured ROM was flexion to 100 degrees and extension 0 degrees, with an inability to tolerate repetitive testing. The VA X-ray demonstrated degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, coded 5299-5003 (analogous to degenerative arthritis). The PEB additionally adjudicated residual patellar instability after surgery diagnosis as a Category II condition that contributes to the unfitting condition. The panel agreed that this condition was intrinsic to the rated condition such that separate rating could not be supported without violation of VASRD §4.14 (avoidance of pyramiding); thus, it was appropriately subsumed in the same rating. The VA rated the right knee condition 10%, coded 5010 (traumatic arthritis), based on the C&P examination and citing painful motion. There were no other criteria in evidence to support a rating higher than 10% under any applicable VASRD §4.71a code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

2	PD-2017-05178

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.